Individual
DESTANEE MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
136 WILLIAM ST, SPRINGFIELD, MA 01105-2324
(413) 331-6600
Mailing address
140 YALE ST, SPRINGFIELD, MA 01109-3435
(413) 777-2210
(413) 777-2210
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/12/2025
Last updated
05/12/2025
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